Abstract
We report a case of intoxication by metoclopramide, an antiemetic
neuroleptic, in a breastfed child, causing an extrapyramidal syndrome. A
21-week-old breastfed child was brought to the pediatric neurology
consultation following two episodes of unexplained dystonia. The
anamnesis revealed that the mother had taken a rectal suppository of
metoclopramide (10 mg) 48 hours before the first episode. The father was
also treated by paracetamol codeine for capsulitis and the child had
received paracetamol for teething. Blood toxicology analyses were
performed at the first episode. A 3-cm strand of brown hair was
collected during the consultation, one month after the second episode.
The child had no further episodes of dystonia since the second event.
The child’s blood toxicology analysis revealed the presence of
metoclopramide at a concentration of 8 ng/mL. Hair analysis revealed
metoclopramide at a relatively high concentration, with paracetamol,
lidocaine, diazepam and nordazepam, and codeine. The presence of
diazepam can be explained by medical care. The low concentration of
codeine without its metabolite morphine, may suggest an external
contamination by the environment, contact with people who had consumed
this molecule, especially the child’s father. The interpretation of hair
analysis in infants remains nevertheless delicate to discriminate
consumption from environmental contamination. The presence of
metoclopramide in the blood and hair is compatible with a passage of
breast milk to the child. According to the literature, less than 5% of
the maternal dose is found in the child. No case of intoxication through
breast milk has been described, to our knowledge.